Provider Demographics
NPI:1013550409
Name:IMPACT CHIROPRACTIC, SMITH CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:IMPACT CHIROPRACTIC, SMITH CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-810-4401
Mailing Address - Street 1:3723 LEES AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2333
Mailing Address - Country:US
Mailing Address - Phone:562-810-4401
Mailing Address - Fax:
Practice Address - Street 1:6621 E PACIFIC COAST HWY STE 120
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4244
Practice Address - Country:US
Practice Address - Phone:562-414-5001
Practice Address - Fax:562-414-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770822900OtherNPI